Akciğer Kanserinde Tümör Belirteçlerinin Tanısal Değeri
Özet
Early diagnosis, differential diagnosis and histological subtyping are important issues in the initial evaluation of patients with lung cancer. In this study, we aimed to investigate the diagnostic value of tumor markers in newly diagnosed patients with lung cancer. Venous blood samples were collected from 99 patients with lung cancer (42 adenocarcinoma, 35 squamous cell carcinoma, and 22 small cell carcinoma (SCLC)) at the time of initial diagnosis and from 30 patients with benign lung disease. Pro-gastrin releasing peptide (ProGRP), squamous cancer cell antigen (SccAg), cytokeratin 19 fragments (Cyfra 21.1) and human epididymis protein 4 (HE4) were measured by chemiluminescent microparticle immunoassay. Chromogranin A (CgA) was measured by automated random access immunoanalyzer (TRACE method), neuron specific enolase (NSE) was measured by electrochemiluminescence immunoassay. The diagnostic value of tumor markers was assessed with receiver operating characteristic curve analyses, the area under the curve (AUC) was calculated. Serum Cyfra 21.1 (p<0.001), ProGRP (p=0.005), SccAg (p=0.001) and NSE (p=0.03) levels were significantly higher in patients with lung cancer. While ProGRP levels were higher (p=0.009) in SCLC patients; Cyfra 21.1 (p=0.019) and SccAg (p=0.001) levels were higher in NSCLC patients. The sensitivity and specificity of tumor markers were 71.7% and 83.3% for Cyfra 21.1; 69.7% and 56.7% for HE4; 18.1% and 93.3% for ProGRP; 43.4% and 76.6% for SccAg; 53.5% and 53.3% for CgA; 72.7% and 50% for NSE. Cyfra 21.1 (p<0.001, r=0.394), HE4 (p=0.014, r=0.279) and CgA (p=0.023, r=0.259) levels were positively correlated with stage in patients with NSCLC. Cyfra 21.1 had the highest diagnostic value for lung cancer (AUC=0.865). When it is combined with HE4, diagnostic value increased (AUC=0.899). ProGRP had the highest diagnostic value (AUC=0.875, p<0.001) for discriminating SCLC from NSCLC followed by NSE (AUC=0.694, p=0.006) and CgA (AUC=0.663, p=0.02). A panel of three tumor markers including Cyfra 21.1, HE4 and ProGRP may play a role for the discrimination of lung cancer from benign lung disease and the subtyping as SCLC.
